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Table 1 Therapeutic effects of exosomes from three sources in tendon injury

From: A “cell-free treatment” for tendon injuries: adipose stem cell-derived exosomes

ASC-Exos

BMSC-Exos

TSC-Exos

Compared with exosomes from other sources, ASC-Exos gradually become the main substances used in "cell-free therapy". ASC-Exos modulate the phenotype of macrophages, suppress the inflammatory response, improve the immune effect, stimulate the proliferation and migration of tendon cells, and maintain tendon metabolic homeostasis, thus improving the expression of histological and mechanical properties of damaged tendons. Moreover, some pretreatments (e.g., hypoxia or chemical treatment) can further modulate the immunosuppressive effects

BMSC-Exos have been very well received in clinical practice as the first "cell-free therapy" technology to be implemented. They promote angiogenesis, inhibit the secretion of pro-inflammatory factors to slow down the inflammatory response, as well as modulate some immune system related biological factors and encourage the regenerative capacity of tendon resident stem/progenitor cells. Therefore, BMSC-Exos can be one of the effective therapeutic tools for the treatment of immune-related diseases

TSC-Exos mainly act on the proliferation and migration of tenocytes, thereby indirectly promoting tendon healing. They mainly change the ratio of matrix metalloproteinase 3 and its inhibitors, regulate the degradation and synthesis of ECM, and enhance the mechanical properties of tendons